The language of AA/NA

For example, mental health calls a period of not using a drink or drug sustained remission, according to the DSM. AA/NA calls it staying sober or staying clean, or being in the fellowship, or abstinence. There is a subtle but important distinction in the meaning of these terms.

Sustained remission comes in stages and can be, and usually is, sustained by some drug or medication. It does not have to be, but it usually is. People are diagnosed with a mental illness before sustained remission actually occurs, and they are medicated to match that diagnosis often while still in detoxification, or stages of protracted withdrawal. It used to be that sustained remission would be stable before diagnosing a mental illness or co-occurring disorder. Not any more, because the health insurance process demands a diagnosis immediately to justify payment for services, and so the whole process has been reversed.

Staying sober or staying clean is just that. And the alcoholic or addict is sustained by the fellowship and by developing a sense of depending on a Higher Power of some kind or other.  What the Higher Power is to an individual is up to them. Literally. AA/NA is a spiritual program, not a religious program.

That is a vastly different process, language and experience.

A slip, A convincer

Relapses, or slips as they are termed in AA/NA, mark the beginning of a time of grave risk to alcoholics and addicts.  One of those things that is primarily known anecdotally in AA/NA is that somehow people revert back to the exact former stage of their chronic alcoholism in a very, very short time despite lengthy abstinence.  This is well known in the wisdom of AA/NA, but not part of the thinking of mental health/psychology.

In mental health/psychology the belief is that this does not occur, that people will not revert to this extent so quickly.  They believe that a slip is a momentary relapse and is largely inconsequential if it does not continue for any great length of time. It is part of the process, they contend.

This belief stems from the understanding of the process of mental disorders diagnosis and treatment and the progression of diseases they are familiar with treating.  It is carried over in situ into substance abuse treatment as is.

They do not seem to understand the differences in the process of the treatment of addiction. One true reason for this is … addiction understanding is largely experiential.  It is true that the only real understanding of the experience of addiction is the one that comes from those who have been through it and are now abstinent and in AA/NA or have found another means to stop drinking or using for a stable amount of time.

This is true, whether people want it to be true or not. And, it is the reason why forcing those with that experience out of the professional treatment of addiction has rendered it ineffective.

Why this is a problem

The rift between mental health/psychologically based treatment theory and disease concept/AA/NA 12 Step is killing addicts and alcoholics every day. These two approaches to dealing with a life threatening, progressive condition sets up a incompatibility of belief systems that prevents those afflicted from being able to grasp the rope that pulls them out of despair.

Because people who started their treatment in a mental health environment can not give themselves to a second system that sees the path from a completely different perspective. Yet when people leave the mental health based system the only lifeline they have to use for the rest of their lives is the AA/NA in their own neighborhoods and communities.

Once the treatment has passed the stage when there is money to be made, then these vulnerable souls are expected to be able to cope with this complete change of locus of control on their own.

It is really sick.

Confrontation vs. feel good support

Because denial is part of the disease, or pattern, or symptoms or reality of addiction confrontation is necessary as part of the process of recovery. This is another key area where mental health treatment and 12 Step programs differ completely.  What does denial mean? It means you are absolutely convinced you do not have a problem with drinking or drugs.

So how can you soft pedal to get the attention of someone who will lie, cheat and steal to get what they need to keep their buzz going? It’s harder than that, and mental health treatment professionals don’t wnat to do the really distasteful, hard job of getting in people’s faces and telling them the cold, hard fact that they are out of control and hurting everyone around them.

People who have had experience in therapeutic community treatment milieu  know how to confront someone, clarify what the real problem is, and then put the person back together emotionally and point them in the right direction.  It is an act of love, not an attack.  But they don’t teach that in school, you have to be in it to learn how it works and it is being lost every day as mental health usurps addiction treatment across the board.

Art Therapy effective with addiction

Art therapy is particularly effective in working with addicted folks. Why? Because the whole point of being addicted is to avoid reality and emotions… and art therapy allows people to experience emotions under controlled circumstances.  Addicts and alcoholics are so ‘glib’… such excellent cons, that even they don’t know what they feel.  So when images acquaint them with their own emotions, through the images they created  themselves, they are then able to discuss them within the contained image space.  It works so very well. I know it should be primary therapy of choice. Verbal therapy is less effective because of the glib con factor.  There is also the link between creativity and addiction… but that’s another subject.